Toward the identification of CME content needs for primary care physicians.

While continuing medical education (CME) has been accepted as effective in changing the clinical behavior of participants, there is still uncertainty as to the most effective method of determining content that is practice relevant and clinically important to an identified population of participating physicians. This article proposes a model for developing a knowledge examination that can be administered to CME audiences to detect deficiencies of knowledge that will be helpful in CME program planning. It further proposes that such an instrument be based upon the following assumptions: (1) that core competencies can be identified by content specialists; (2) that the relevance to practice can be determined by reviewing practitioners who represent the target audience (content and face validity); (3) that eight management stages should be sampled by the instrument to assure that all management areas of clinical practice are included; (4) that the test items be tested and retained, revised, or discarded according to the results of item analysis (validity); (5) that test items should be written to represent application and problem-solving use of knowledge; (6) that medical problems for which test items are written should be selected on the basis of potential for improving mortality or morbidity. For example, in the case of cancer, most would agree that colorectal cancer represents an area where better application of current concepts would result in improved mortality rates. With use of a test instrument constructed on the basis of these assumptions, it should be possible to sample what physicians need to know that is relevant to their practices--the proactive model.(ABSTRACT TRUNCATED AT 250 WORDS)